Page 146 - Nutrition Counseling and Education Skills: A Guide for Professionals

toasted garlic bread and milk. Usually, they will have dessert and share a bowl of ice cream or a brownie
when they watch a movie at home.

Treat a man as he is and he will become who he is; treat a man as he can and should be and he will become as he can
and should be.

—Goethe

Introduction

Lose weight! Quit smoking! Control your blood sugar! This advice is easily uttered but requires a process to
implement and maintain. This process is referred to as behavior modification. Changing behaviors is one of
the most difficult tasks for people because human behavior is quite complex. Complex behaviors usually are
based on a combination of inherited and acquired characteristics. The inherited characteristics cannot be
changed, just as it is impossible to alter any genetic attribute. However, the acquired characteristics, those
shaped by a person’s environment and experience, can be altered. Behaviors that are learned or acquired can be
changed or modified, but this usually requires the right approach at the appropriate time.

Consequences drive behavior. Most undesirable behavior is acquired and maintained by the same principles
as optimal behavior, and in some cases the unhealthy behaviors will naturally change.1 However, the role of a
counselor in behavior change is warranted in some situations to highlight for the patient the cost–benefit
trade-off or reveal how the “pros” outweigh the “cons” of change.

In behavior modification, the counselor attempts to alter previously learned behavior or to encourage the
development of new behaviors.2 For example, it is often difficult to influence patients who may not see the
health danger in their current habits. Food preferences and eating behaviors have deep roots within the
individual and may be highly resistant to change. In addition, behaviors may define individuals in terms of
what they think and feel and how they react to certain situations.1 Reluctance to make changes may occur
when a good rationale and a stepwise process to change are not identified. Counseling for behavior change can
help reduce the resistance to change.

Simply furnishing information about what to eat is often insufficient to promote alterations in eating
behaviors or adherence to medical nutrition therapy. In these instances, it may help to differentiate between
diet instruction and behavior modification. In fact, the standardized language of the Nutrition Care Process
(NCP) distinctly separates nutrition knowledge from client behaviors that influence nutrition-related goals.3

Contrary to traditional diet instructions, nutrition counseling for behavior modification steers the client
into assuming responsibility for change.4 The transfer of decision-making power from the professional to the
client reduces the risk of relapse and failure. Over time, even individuals in the best designed, short-term
intervention can relapse after the formal program ends. If the responsibility for decisions is transferred to
clients, they are much more likely to modify eating choices. As difficult as this seems, it is even more
challenging to effectively implement this approach in acute care nutrition intervention settings. Along with
information on nutrition, behavior modification principles may be used because they offer the nutrition and
dietetics professional an additional dimension to counseling—that of combining the sciences of psychology
and physiology with the art of therapy.4

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